Liver Flashcards
most common class for acute liver failure
antibiotics
amoxclav
liver functions
protein synthesis - clotting factors
bile secretion
biotransformation and detoxification
regenerative organ
metabolic induced liver toxicity
oxidative stress
mitochondria
immune mediated liver injury
immune reaction
ADCC
CDC
factors that affect drug toxicity
age: poor IS so harder to have immune response gender diet - caffiene, alcohol diseases- diabetes, hepatic, renal enzyme polymorphism drug drug interference
signs of direct hepatotoxicity
expected, dose related distinctive morphologic pattern reproducible in animals no extrahepatic signs of hypersensitivity serum enzyme elevations likely oxidative stress mediated
signs of acute hepatic necrosis
sudden direct heaptic toxicity increased ALT, AP, and bilirubin ALT INR elevated rapid improvement
signs of idosyncratic hepatotoxicity
unexpected outcome not dose related rare variable lesions not reproducible in animals hypersensitivyt signs
idosyncratic hepatotoxicity likely due to
immune mediated - rash fever
idiosyncratic phenotypes
acute hepatitis
hepatocellular
cholestatic
mixed
cholestatic vs hepatocellular hepatotoxicity
R>5 = hepatocellular R<2 = cholestatic R=2-5 = mixed r = ALT/AP
describe indirect toxicity
meds induce or alter a preexisting liver condition
can be predicted or avoided
reactivate hep B or C
phenotypes of indirect hepatotoxicity
acute hepatitis
acute liver failure
chronic hepatitis
fatty liver
phenotypes of drug induced liver injury
a whole shit ton
diagnosing phenotypes of drug induced liver toxicity
histological
clinical
labratory
noninvasive imaging
symptoms to prompt testing for liver injury
fatigue nausea anorexia maliase right upper abdominal pain jaundice
treatment of drug induced liver injury
stop causative agent
what does hy’s law suggest
jaundice that appears after drug induced hepatocellular injury = serious problem
mortality rate >10%
hy’s laws
drug causes alanine transaminase>3xULN more than placebo
total bilirubin>2x ULN
no other reason can be found to explain the combo of increased AT and TBL
alcohol liver disease
alcohol level
history of alcohol use
ration of AST to ALT 2:!
diagnosis of viral hepatitia
hep A, B, C, or E antibody
diagnosis of hemodynamic liver disease
hypotension
shock
heart failure
vascula occlusion
what is happening in this lecture
no damn clue
